Is there a doctor in the house? Technically, yes, there are 18 physicians serving in the 114th Congress. But a regular M.D. may not be enough to save what is ailing today’s Republican Party, where two men, exact opposites in temperament, experience and political inclinations sit atop the GOP like conjoined twins fighting for survival.

The twins, let’s call them Paul and Donald, don’t share a brain or a heart, but they rely on the same vital organs to stay alive.

Paul, the younger twin, is Paul Ryan, the new House speaker and second in line to the presidency. Pragmatic, earnest, patient, the 45-year-old has risen through the GOP power structure over the course of two decades, from staffer to back-bencher to Ways and Means chairman to speaker. His first job in high school was at McDonald’s.

Donald Trump is our older twin, for argument’s sake. He is impulsive, often crude, prone to rants, and sometimes brilliant, and is now the Republican front-runner for the presidency. He’s never held a job in politics other than (admittedly) trying to influence lawmakers with donations and wondering aloud where Barack Obama’s birth certificate could possibly be. Donald worked in real estate his whole life, and, as he tells it, got his start with a “modest $1 million loan” from his father.

The same Republican Party that elected Paul Ryan speaker eight weeks ago also rocketed Donald Trump to the top of the national polls eight weeks before that. The men ascended at essentially the same time, but it’s hard to believe they’ll both make it through 2016 politically alive. The survivor will decide the course of the party on issues large and small, but their words over the course of the last several months show just how significant those differences are.

On immigration

Trump: “We are becoming the world’s dumping ground for everybody else’s problems. When Mexico sends its people, they're not sending their best. They're sending people that have lots of problems ... they're bringing drugs, they're bringing crime. They're rapists. And some, I assume, are good people."

Ryan: “Legal immigration is America. My name is Ryan. I think you could have a pathway to legal status. Earn your way to legal status, but not to citizenship.”

On Muslims traveling to the U.S.

Trump: “Donald J. Trump is calling for a total and complete shutdown of Muslims entering the United States until our country's representatives can figure out what the hell is going on.”

Ryan on Trump’s proposal: "This is not conservatism. What was proposed ... is not what this party stands for, and more importantly, it's not what this country stands for.”

On the $2 trillion omnibus spending bill

Ryan: "This bipartisan compromise that secures meaningful wins for Republicans and the American people."

Trump: “Elected leaders in Congress threw in the towel and showed no budget discipline.”

On Social Security and Medicare

Ryan: "The good news on these issues is that if we reform them for the next generation now, we can guarantee – guarantee – that people in or near retirement don't have any changes in their benefits."

Trump: “We’re going to save Medicare and save Social Security and we’re not going to raise the age. We’re going to increase jobs and make ourselves rich again.”

On each other

Ryan on Trump: Ryan won’t comment on Trump because he says his position chairing the Republican convention requires him to stay neutral. But when asked about Trump, he told reporters, “I will stand up for what I believe. I will stand up for what I believe is right. I will stand up for our party's principles and our nation's principles."

Trump on Ryan, via Twitter, of course: “Paul Ryan is far from my first choice, but a very nice guy. The Republicans should go for tough and (very) smart this time – no games!”

Between the two, Republicans have a speaker who thinks before he talks and a screamer who hardly seems to think at all. One makes sense. The other makes headlines. Washington Republicans have chosen Paul Ryan, but the GOP’s grassroots voters — the ones who go to the rallies and man the phone banks and fuel successful elections -- seem to want something else entirely.

Trump and Ryan could both survive at the top of the party, but that would only seem to delay, not decide, knowing what type of party Republicans will have in the future.

There’s no easy answer between choosing the head or the heart, but at least Republicans have Ben Carson to go to. He won’t be the presidential nominee, of course, but he has separated conjoined twins before.